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I Haven't Been Answered Yet
Apr 14, 2010

Dr. Bob, I'm very sorry to post again; I saw you answered a new slew of questions and mine was not included and I am so unbelievably anxious.

Here is my situation: I am a 21 year old in nursing school. During clinicals at a hospital, apparently a nurse tech had discontinued an IV of a patient and did not apply pressure because he was bleeding profusely when I was pulled into the room. (due to blood thinners.) I applied pressure above the site to occlude the artery (stupidly without gloves because it was an impulsive/instinctual move) and the patient moved, resulting in me getting some of his blood on my left hand. Within about 20 seconds I washed the blood off with soap and water, reapplied gloves, and cleaned up the rest of the blood. Later I noticed I had an open hangnail on my left thumb, although it was not bleeding. I could not remember if the blood had gotten on the hangnail or not. The patient was being discharged that day. This happened about 4 weeks ago.

This is what I know about the patient: (I found out more today.) He is a 67 year old white male who was admitted for a CABG surgery. He also has severe PAD in both of his lower extremities and had to have his right big toe amputated due to dry gangrene as well as a femoralpopliteal bypass to his right leg. He has a history of alcohol use but stopped "drinking beer" three months prior to his CABG. He also used to smoke about 2-4 packs of cigarettes a day until he quit in 2007. He has been married 3 times, is currently in his recent marriage of about 20 years, and has 2 kids and some grandchildren.

I know I am being irrational about a lot of things. Number one- I know my risk of exposure was very small. Number 2- I know the patient's likelihood of having something such as HIV would be unlikely given his age and all, but it's still not impossible. I have no way of knowing if this man has HIV and that is what absolutely terrifies me. I have lost sleep, my grades are slipping, and I am causing so many problems and so much stress for my family over this. I can't get over this fear and worry.

My questions to you- Am I at significant risk for contracting HIV from this exposure? Should I be tested for HIV and/or hepatitis? And yes I have had the hepatitis B vaccination series. It is hepatitis C I am worried about. Could enough blood get into my hangnail to cause me to become infected? I know you don't know this patient, but what would you say the likelihood of him having HIV would be?

I am so terrified, Dr. Bob. I have finals coming up and I am worried about not passing. This only happened about 4 weeks ago so it is still too soon for me to get a conclusive HIV test. I can't function anymore!!

-WORRIED.

Response from Dr. Frascino

Hi Worried,

I can only respond to a very small percentage of the gazillions of questions that cram their way into my overstuffed inbox on a continual basis from throughout the cyber-universe. I frequently encourage questioners to check the archives before submitting their questions because as it turns out I've already addressed the vast majority of common (and sometimes not-so-common) concerns numerous times over the years.

Regarding your potential occupational risk:

1. Most likely the IV was in a vein rather than in an artery as you suggest; otherwise the hospital room would have resembled a scene from a Quentin Tarantino film.

2. The chance the patient was HIV infected is remote at best.

3. Your HIV-acquisition risk is negligible.

4. As with all occupational exposures or even potential occupational exposures, you should have reported the incident. All training programs and health facilities have policies and procedures in place to document, evaluate and manage blood-borne pathogen exposures (HIV, hepatitis). (A prompt evaluation would have put your fears to rest four weeks ago!) If necessary a source patient can often be rapid HIV tested and/or screened for hepatitis. Follow-up HIV and hepatitis C testing for the healthcare worker could be arranged if warranted. Even though it's four weeks overdue, I would still report this incident to your supervisor and/or the occupational medicine division. From what you have written, I would assess your risk as negligible. Certainly PEP was not warranted. Routine follow-up HIV-antibody testing might be offered, but I currently don't think it's essential for such a minimal potential risk.

Good luck.

Dr. Bob



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